TitleThe school experiences of autistic girls and adolescents: a systematic review

Authors

Carla Tomlinson (corresponding author), Caroline Bond and Judith Hebron

Carla.tomlinson@postgrad.manchester.ac.uk

Post: Rm. A6.20. Ellen Wilkinson Building, University of Manchester, Oxford Road, Manchester, M13

9PL.

Twitter: @CarlaHTom

Caroline.bond@manchester.ac.uk

Post: Rm. A6.20. Ellen Wilkinson Building, University of Manchester, Oxford Road, Manchester, M13

9PL.

Twitter: @Carolin077Bond

Affiliation

Institute of Education, University of Manchester, Manchester, UK

J.hebron@leeds.ac.uk

Post: 2.16b School of Education, University of Leeds, Leeds, LS2 9JT, UK

Twitter: @judithhebron

Affiliation

School of Education, University of Leeds, Leeds, UK

‘This project was funded through England’s Department for Education (DfE) National College for

Teaching and Learning (NCTL) ITEP award 2016-2019’.

Total word count: 7,081 excluding title page

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Abstract

The purpose of the current review is to provide an overview of research relating to the school

experiences of autistic females throughout childhood and adolescence.

Web and database searches were conducted between December 2017 and April 2018 to identify

studies exploring school experiences of autistic females. Eight studies met the inclusion criteria and

the data were analysed using a framework synthesis methodology, where a conceptual framework

of general autistic experiences in education was used to map study findings onto. Key themes were

identified, highlighting similarities between autistic girls and boys in several areas, including sensory

issues and difficulties with peer relationships. Noteworthy differences included contrasting

perspectives between staff and parents in relation to the girls’ experiences, as well as the greater

tendency for girls to mask their difficulties. The implications of these findings are discussed in the

context of professional practice and directions for further research.

Keywords: autism, autistic, gender differences, educational experiences, school experiences, social

experiences

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Introduction

Autism is a pervasive developmental disorder, characterised by persistent impairments in social

communication and interaction, alongside restrictive or repetitive interests, activities or patterns of

behaviour and sensory sensitivities (APA 2013). In England most autistic children are educated in

mainstream settings (Department for Education (DfE) 2018). However, research suggests that

experiences of education for autistic children can be significantly worse than for ‘typically

developing’ (TD) children, particularly when appropriate provision is not in place (Humphrey et al.

2015). Although autism is more likely to be diagnosed in boys, there is increasing awareness of

autism in girls (Gould and Ashton-Smith 2011). This review seeks to provide a systematic synthesis of

girls’ experiences of education to inform education practice and research. The following sections

describe autistic young people’s experiences of education in general before focusing specifically on

gender differences in autism.

Autism and education

Education-based research, though focused predominantly upon boys, has proposed that autistic

children report fewer friendships (Kasari et al. 2011), and less social support from their peers than

those without Special Educational Needs (SEN) or with other types of SEN (Humphrey and Symes

2010). Indeed, difficulties with social relationships is a key finding in the extant literature

(Humphrey and Lewis 2008; Poon et al. 2014), though it is worth noting that although friendships

may look different, often autistic children are happy with their interactions (Calder Hill and Pellicano

2013). More worryingly, pupils with autism are likely to experience higher levels of loneliness and

social isolation (Bauminger and Kasari 2000; Schroder et al. 2014) and increased bullying

(Cappadocia, Weiss and Pepler 2012; Rowley et al. 2012) compared to their peers. Chamberlain,

Kasari and Rotheram-Fuller (2007) found that although autistic pupils reported involvement in social

networks they rated friendship qualities such as acceptance, companionship and reciprocity as lower

than those of their TD peers. Access to high-quality friendships has a significant impact on

emotional well-being and the negative consequences of difficulties in developing and maintaining

friendships is well documented (see Danker, Strnadova and Cumming 2016 for a review of the

literature).

A further key difficulty relates to the physical environment, and the design of the mainstream school

can be an important facilitator or barrier to a truly inclusive environment (Bond and Hebron 2016;

McAllister and Maguire 2012). Coping with the sensory demands of a busy environment and

frequent transitions (Banda et al. 2009) can increase anxiety (Goodhall 2015), leading to pupils

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becoming distanced from the learning process (McAllister and Maguire, 2012), and can contribute to

academic underachievement compared to TD students (Asburner, Ziviani and Rodger 2010).

Sex differences in autism

Traditionally, autism has been conceptualised as a principally male condition and differential rates of

diagnosis range from a male/female ratio of 2:1 to 16:1 (Gould and Ashton-Smith 2011). The ratio is

smaller in those individuals at the lower end of the IQ distribution and greater at the high-

functioning end (Rivet and Matson 2011), with the suggestion that this may be partly due to the

under-identification of females because of bias in diagnostic tools (Lai et al. 2015). Girls may also be

mis-diagnosed with conditions such as anxiety and depression or diagnosed with autism later than

boys (Begeer et al. 2013). Research suggests that although autistic females may demonstrate similar

difficulties with social communication compared to boys (Van Wijngaarden-Cremers et al. 2014) they

often exhibit fewer repetitive or restricted behaviours (Frazier et al. 2014; Van Wijngaarden-Cremers

et al. 2014), and the interests they show are like those of TD girls, varying only in intensity and

severity (Gould and Ashton-Smith 2011). Furthermore, girls may be less likely to be identified due to

their propensity to display internalising behaviours compared to the externalising behaviour of their

male counterparts (Mandy et al. 2012), with the implication that girls may be more likely to be

overlooked within educational settings. This is amplified by the tendency of autistic females to

camouflage to ‘fit in’ or not be noticed (Attwood 2006).

Rationale and aims of the current review

Most studies exploring the experiences of autistic children and adolescents focus on males (Gould,

2017), though recently there has been a move towards research utilising solely female samples to

better understand girls’ experiences specifically (e.g. Cridland et al. 2014; Moyse and Porter 2015).

The aim of the current review is to provide a systematic synthesis of findings of research studies

investigating the school experiences of autistic girls and adolescents. The literature review question

(LRQ) was defined as follows:

‘What are the school experiences of autistic girls and adolescents?’

Methodology

Review process

Although there is growing awareness of autistic girls (Gould, 2017), there is limited guidance for

schools in meeting their needs and provision could be more specifically targeted. The current review

therefore aims to inform professional practice in this area. Given that social difficulties are a core

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deficit in autism and a presenting issue causing many problems among school-age girls, the review

adopted a broad definition of educational experience to include social as well as academic aspects of

school experience.

To identify the included studies a systematic search strategy was employed, following the Preferred

Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) approach (Moher et al. 2009)

(Fig 1). Between December 2017 and April 2018, systematic searches of the following databases

were undertaken; Psych Info, Education Resources Information Centre (ERIC), Web of Science,

Applied Social Science Index and Abstracts (ASSIA) and the British Index of Education (BIE). Further

searches were made using Google Scholar. The search terms employed were males AND females OR

boys AND girls, ASD OR ASD OR aut* and education OR school OR social. Searches were conducted

using single and combined terms. Reference harvesting from retrieved papers was undertaken to

ensure that all relevant literature had been identified. The initial search yielded 285 papers of which

269 were excluded after removing duplicates and screening titles and abstracts for relevance. The

remaining 16 articles were considered for further analysis utilising the following pre-defined

inclusion criteria:

1. Studies included females with a clinical diagnosis of autism (including Asperger’s Syndrome)

who were under 18 years of age or 18 years and older reflecting on their school experiences.

2. Data focused on the experiences of autistic girls including their narrative accounts, peer

nomination data or parent or teacher reports of the girls’ experiences.

3. Studies focused explicitly on the experiences of females or included the male and female

experience, with relevant aspects of the female experience drawn out of the data.

4. Quantitative, qualitative or mixed-methods studies were deemed appropriate due to the

lack of research in this area.

5. Papers were written in English.

6. Papers published in a peer-reviewed journal.

7. Studies utilised primary or secondary data to maximise scoping.

Initial scoping revealed that there was likely to be limited research in this area, so no date range was

set. Following this process, a further eight papers were excluded for the following reasons; the study

focused primarily on behavioural presentation in relation to the diagnostic criteria or findings were

not related to education, participants were over 18 years and were not reflecting on childhood or

adolescent experiences or the target females did not have a diagnosis of autism.

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Figure 1 PRISMA Framework

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284 records identified through database searching

1 record identified through reference harvestingIdentification

267 records after duplicates removed

267 records screened 251 records excluded

Screening

16 full text articles assessed for eligibility

5 qualitative studies included

in synthesis

1 quantitative

study included in synthesis

8 full text articles excluded, with reasons

2 mixed methods

studies included in synthesis

Eligibility

Included

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Evaluative frameworks

The remaining 8 papers were assessed for methodological quality using Gough’s (2007) Weight of

Evidence A (WoE A) criteria. Given that research into the experiences of autistic females remains in

its infancy the papers were screened for quality; not as a tool to exclude from the review but rather

to highlight what good quality research might look like in this emerging field. Both quantitative and

qualitative investigations were assessed using the scoring framework developed by Bond et al.

(2013). Qualitative papers were considered against twelve criteria including appropriateness of the

research design, clear sampling rationale and evidence of explicit reflexivity. Those receiving a total

score between 0-5 were considered ‘low quality’, 5.5-9.5 ‘medium quality’, and 10-14 ‘high quality’.

The criteria against which quantitative papers were assessed included clear research question(s),

comprehensive data gathering and appropriate statistical analyses, with scores of 0-5 classified as

‘low’ quality, 6-10 as ‘medium’ and 11-15 as ‘high’. Mixed methods studies were dual coded using

both the qualitative and quantitative frameworks and were then given the higher point rating.

These boundaries enabled the considerable range in quality to be highlighted whilst not excluding

studies.

Data synthesis and extraction

Overall, eight papers were included in the final review and relevant content is summarised in Table

1. A framework synthesis approach (Carroll et al. 2011; Oliver et al. 2008) was adopted to

systematically analyse the findings, involving familiarisation with the theoretical and empirical

literature to develop a conceptual framework (Fig 2). The conceptual framework encompassed the

broad range of factors identified to impact upon school experiences of autistic pupils in general as

reported in the literature. An initial map was developed based upon the first author’s knowledge of

autism and education literature and further refined in consultation with three key educational and

academic experts, widely published in the autism field. This enabled their extensive knowledge of

the literature to inform development of a peer reviewed conceptual map. This framework facilitated

a systematic exploration of the experiences of girls in relation to the general autism and education

literature.

Findings

Overview of the included studies

Eight studies were included in the review, all published between 2014 and 2018, reflecting the

emerging nature of this field. Four studies were conducted in the UK (Cook, Ogden and Winstone

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2018; Honeybourne 2015; Moyse and Porter 2015; Sedgewick et al. 2016), two in Australia (Cridland

et al. 2014; Jarman and Rayner 2015), and two in the USA (Dean et al. 2014; Dean, Harwood and

Kasari 2017). As illustrated in Table 1, one study utilised semi-structured interviews, two employed

a case study method, two used semi-structured surveys, two analysed secondary data and one

employed a mixed methods approach. Most studies focused on the experiences of autistic females

within mainstream educational settings, though two considered the experiences of those in special

schools or both mainstream and specialist settings (Cook, Ogden and Winstone 2018; Sedgewick et

al. 2016). Participant sample sizes ranged from three autistic girls to 100 autistic males and females

and their TD peers, and ages ranged from 5 to 50+ years. Adolescent experiences were the exclusive

focus of three studies, primary (elementary) school experiences in three studies and two studies

considered the experiences of adult autistic females reflecting on their childhood/adolescence.

While studies focused on aspects of school experience, Dean et al. (2014) focused primarily on social

relationships but largely within a school context, and Cridland et al. (2014) highlighted a broader

range of experiences across adolescence, which included school experiences.

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Figure 2 The educational experiences of autistic children and adolescents

Key -----a priori themes

-----emergent themes

vv

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Level of well-being

School level

Classroom level

Individual level Social relationships

Ethos/policy in relation to SEN

including presence of autism advocate

Environment

Sensory issues

Parent-school collaboration

Accessing the curriculum

Managing transitions

Personalised planning

Self-awareness/understanding of autism

Relationships with peers

Frequency/quality of social

interactions

Level of social inclusion

Relationships with staff

Differences in perspective between

staff and parents

Masking difficulties

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Table 1: Characteristics of included studies

Author (s) &

Location

Focus Participants/recruitment method Study Method/Design Summary of Findings WoE A

Cook, Ogden

and Winstone

(2018)

UK

Autistic girls

‘experiences of

learning,

friendships and

bullying

11 girls aged 11-17 years (diagnosed with

autism) and one parent of each girl.

Mainstream and specialist settings.

Purposive sampling.

Semi-structured interviews

Qualitative – thematic analysis

Autistic girls were

motivated to have

friends but encountered

social difficulties and

were sometimes

targeted for bullying.

Medium

Cridland et al.

(2014)

Australia

Autistic

adolescent girls’

experiences

during

adolescence

Three mother-daughter dyads and two

additional mothers.

Girls aged 12-17 years diagnosed with

autism.

Recruited through local schools and

community groups.

Multiple case study approach

Qualitative – Interpretative

Phenomenological Analysis (IPA)

Social, physical,

emotional and sexual

issues identified.

The authors likened

some experiences to

those of autistic boys

e.g. transition, others

were viewed as specific

to autistic girls e.g.

socialising with neuro-

typical girls.

Medium

Dean et al.

(2014)

USA

Social

relationships of

elementary

100 elementary school children (1st to 5th

grade)

25 autistic girls, 25 TD girls

Secondary analysis of peer nomination data

using ‘The Friendship Survey’ in two earlier

studies (AIR-B, 2012; Kasari et al., 2011)

Autistic children

socialised with same

gender friends.

Medium

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school children

with autism

25 autistic boys, 25 TD boys

Autistic children matched by age, gender

and IQ with a TD classmate by age and

gender.

All autistic females included from earlier

studies (AIR-B, 2012; Kasari et al., 2011),

other group participants randomly

selected from these studies.

Quantitative – ANOVA and regression analysis Autistic girls and boys

were more socially like

each other than same-

gender controls with

fewer nominations and

social relationships.

Autistic boys overtly

socially excluded;

autistic girls overlooked

by TD peers.

Dean, Harwood

and Kasari

(2017)

USA

How gender-

related social

behaviours

enable autistic

girls to mask

symptoms

96 elementary school children (1st to 5th

grade)

24 autistic girls, 24 TD girls

24 autistic boys, 24 TD boys

TD children were matched by sex, age and

city of residence to autistic children.

All autistic females included from the

previous study. Autistic males and TD

males and females randomly selected

from the study (Kasari et al., 2015).

Secondary analysis of observational data

collected using The Playground Observation

of Peer Engagement (POPE) in a previous

study (Kasari et al., 2015)

Mixed methods- ANOVA

Autistic girls used

compensatory

behaviours, e.g. staying

close to peers masking

social challenges.

Autistic boys’ social

difficulties were more

obvious.

Medium

Honeybourne

(2015)

UK

School

experiences of

autistic women

and girls

67 autistic females aged between 14 and

50+ years (65 in USA, 2 in UK)

Self-selected sample

Participants recruited, and semi-structured

survey distributed via face-to-face interviews,

email, online surveys and Facebook groups

Qualitative – analysis of general themes

Difficulties covered

friendships,

communication,

learning, interpreting the

Low

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world of school and

feeling misunderstood.

Jarman and

Rayner (2015)

Australia

What parents of

school-aged

females with

Asperger’s

syndrome (AS)

and adult females

with AS want

teachers to

understand.

Parents of females aged between 5 and 18

years with a diagnosis of AS (n=15)

Adult females aged 18 years and older

with a diagnosis of AS (n=30)

Recruited via advertisements on AS and

autism related websites.

Semi-structured survey distributed online

Qualitative –

Inductive thematic analysis

Key themes; teachers’

recognition of the AS

diagnosis in females; lack

of understanding of

challenges associated

with AS; and helpful

attitudes and action of

teachers.

Medium

Moyse and

Porter (2015)

UK

Effects of the

‘hidden

curriculum’ on

autistic girls

3 autistic girls aged 7-11

Purposive sampling

Case study method; incorporating semi-

structured interviews with each girls’ mother,

class teacher, and SENCo alongside

discussions as well with the girls themselves

Qualitative –

Thematic analysis (hybrid approach)

Key themes; working

collaboratively; class

rules; completing tasks;

and other interactions

with peers.

Medium

Sedgewick et al.

(2016)

UK

Exploration of

gender

differences in the

social motivation

and friendship

experiences of

46 adolescents aged 12 to 16 years (13

autistic girls, 13 TD girls, 10 autistic

boys ,10 TD boys).

Independent clinical diagnosis of autism

(n=19 boys; 10 girls) or AS (n=4 boys; 3

girls).

Adolescents completed the Friendship

Qualities Scale (FQS)

Teachers completed the Social

Responsiveness Scale – 2nd edition (SRS-2)

Semi-structured interviews conducted with

adolescents

Autistic girls had similar

social motivation and

friendship quality to TD

female peers but both

groups reported higher

levels of relational

Medium

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autistic

adolescent boys

and girls

compared to TD

peers in specialist

settings

Sampling not specified Mixed-methods – ANOVA and thematic

analysis

aggression than autistic

and TD boys.

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The eight papers were systematically analysed in relation to the main themes of the conceptual

framework (Fig 1) and the findings are presented below. There were overlaps in some reported

findings, thus they may have been mapped under more than one area.

School level

Environment

Difficulties managing the school environment were highlighted by several studies (Honeybourne

2015; Jarman and Rayner 2015; Moyse and Porter 2015). Challenges included individual sensory

sensitivities making the school environment overwhelming, often exacerbated by a lack of

understanding from school staff regarding the impact of such issues (Jarman and Rayner 2015).

Where staff adopted flexible practices such as allowing pupils to listen to music to help them

concentrate or staying in the classroom at lunchtime to avoid a busy dining hall, this helped

minimise stress and anxiety for autistic female pupils (Jarman and Rayner 2015). Girls themselves

also made their own modifications to reduce anxieties relating to environmental demands, e.g.

controlling space or waiting for other pupils to go before departing for lunch (Moyse and Porter

2015).

Parent-school collaboration

Working with school staff was reported by many parents as a key challenge because of staff

members’ ‘disregard of their daughters’ difficulties, their unwillingness to help (Jarman and Rayner

2015), or misunderstanding their daughters’ needs in relation to autism (Cook, Ogden and Winstone

2019; Moyse and Porter 2015). Despite this, there were clear examples of where collaborative

relationships were beneficial in supporting the needs of autistic females, for example, in the

effective sharing of information (Jarman and Rayner 2015).

Differences in staff and parental perspectives

Difference in perspectives between parents and school staff regarding the challenges presented by

autism was a key theme which emerged during this review. For example, parents assessed their

daughters’ needs as greater in severity than the class teacher or SENCo, impacting on identification

of need (Moyse and Porter 2015), or reported that their concerns were met with scepticism from

school staff (Cook, Ogden and Winstone 2018), often being dismissed entirely (Jarman and Rayner

2015). There appeared to be a consensus amongst parents that misunderstandings were predicated

on the mistaken assumption that autism is a male condition.

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Classroom level

Access to the curriculum

Like the experiences of autistic males detailed in the existing literature there were reported

difficulties accessing the curriculum, including the structure of lessons (Moyse and Porter 2015) and

need for clear instructions and more varied teaching approaches (Honeybourne 2015; Jarman and

Rayner 2015). Activities which required collaboration with peers were also a potential cause of

difficulty (Jarman and Rayner 2015; Moyse and Porter 2015). The need for clear language and

checking of understanding and difficulties was also echoed in specialist provision (Cook, Ogden and

Winstone 2018).

Alternative experiences were reported by some participants including the benefits of having access

to a broader range of subjects in secondary school (Cridland et al. 2014) and finding the work too

easy (Honeybourne 2015). Personalised planning which included visuals and processing time was

identified as supportive by Jarman and Rayner (2015), and one girl’s autism friendly classroom

facilitated a clearer understanding (Moyse and Porter 2015).

Managing transitions

The transition from primary to high school was highlighted as a concern by all mothers in Cridland

(2014). Mothers reported their daughters having difficulty moving between lessons, managing

equipment and coping with different classes and teachers, resulting in parents being regularly called

in to speak to staff.

Transitions within the school day were also identified as a challenge (Honeybourne 2015; Moyse and

Porter 2015), including difficulties moving between the structure of lessons to the unstructured

times of play and lunchtime. Moyse and Porter (2015) observed girls managing these transitions

themselves by making personal modifications such as coming in early from the lunch break, and this

was often endorsed by staff by providing tasks within the classroom.

Individual level

Relationships with staff

Positive relationships with members of staff were highlighted as facilitating more helpful experiences

of schooling through a greater understanding of the needs of those with autism (Jarman and Rayner

2015) or by developing positive relationship with pupils (Jarman and Rayner 2015) often shaping

their experiences of education (Honeybourne 2015).

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Level of understanding of ASD

Essential to the facilitation of positive relationships with both the girls themselves and collaboration

with parents was the knowledge and understanding of staff of autism in females. Mainstream

teachers’ limited knowledge of autistic symptomology in girls was identified as an issue (Cridland et

al. 2014; Honeybourne 2015; Jarman and Rayner 2015), impacting negatively on the flexibility of

teachers and the extent to which they were prepared to make accommodations. Indeed,

participants in Cridland et al. (2014) noted that teachers who knew about autism often understood

more about what it was like in boys.

Where autistic females were making good progress, the effort required to achieve this was

frequently underestimated by teaching staff, including challenges with sensory sensitivities,

handwriting and impaired executive functioning and this often came at a personal cost; ‘after

meltdowns and some self-injury though, I managed to pull through’ (Jarman and Rayner 2015

p.134).

Masking as a solution

The apparent ability of autistic females to cope with the stresses they face in relation to their

experiences of school emerged in several studies (Cook, Ogden and Winstone 2018; Jarman and

Rayner 2015; Moyse and Porter 2015) where girls were able to hide their autistic traits by modifying

behaviour, often linked to issues of self-identity including girls consciously trying to change their

personality or hide their autism (Cook, Ogden and Winstone 2018). Although it was recognised that

this offered a solution to their difficulties, parents reflected that the implications could be far-

reaching; ‘my daughter holds her emotions in during the day and then melts down in the car and at

home’ (Jarman and Rayner, 2015, 133).

Relationships with peers

Autistic girls often wanted to have friendships but lacked the necessary skills to form or maintain

them, including struggles with perspective-taking (Cook, Ogden and Winstone 2018) and knowing

what was expected of them in relationships (Cridland et al. 2014). Reports from parents supported

this contrast between desiring friendships but struggling to know how to present oneself in social

settings (Cook, Ogden and Winstone 2018).

In studies employing quantitative measures autistic girls were identified as more socially motivated

than autistic boys and the quality of friendships as similar in nature to TD girls in terms of

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companionship, closeness, help and security (Sedgewick et al. 2016). Female participants in this

study were able to name at least one ‘best friend’ in school and most saw their friends outside

school; however, both autistic girls and their TD peers discussed instances of ‘relationally aggressive’

behaviours such as gossiping, being excluded and having their trust betrayed, not reported by the

boys. The complexity of female friendships in adolescence was highlighted in one study by mothers

who felt the social difficulties their daughters experienced were greater than those experienced by

their autistic male peers (Cridland et al. 2014).

Although it may appear externally that autistic females are more socially adept when compared to

their male peers, one study highlighted how this social success may be misperceived with girls using

compensatory behaviours, such as maintaining proximity to their peers, that masks their social

challenges (Dean, Kasari and Chamberlain 2017). Furthermore, Dean et al. (2014) found that social

challenges were equally present in the male and female autistic groups they studied; and in general,

all autistic children in this study had fewer social connections and were less likely to have a mutual

friend. Thus, despite having greater opportunities for social interaction autistic girls are influenced

by both their gender and autism diagnosis. Although all girls in Dean et al. (2014) - both autistic and

TD - were less likely to be explicitly rejected using peer nomination data, autistic girls were also less

likely to be listed as a friend or as a member of a group, leading the authors to identify them as

overlooked rather than specifically rejected compared to autistic boys. Both Cook, Ogden and

Winstone (2018) and Sedgewick at al. (2016) found that relationships were often formed with other

girls with SEN or who were different in some way. This was identified in both specialist and

mainstream settings where girls tended to gravitate towards other girls with autism, perhaps due to

more similar interests.

Level of social inclusion

Reports of social isolation and perceived bullying were prevalent throughout the studies reviewed

(e.g. Cook, Ogden and Winstone 2018; Cridland et al. 2014; Honeybourne 2015; Moyse and Porter

2015) and these were confirmed by parents. In one study (Cook, Ogden and Winstone 2018)

participants from both mainstream and specialist settings reported examples such as being picked

last by team captains in PE or no longer being invited to parties. Bullying was more likely to be

viewed as intentional in mainstream settings and the consequences as more severe than in specialist

settings, for example increased absenteeism (Cook, Ogden and Winstone 2018). Several studies

suggested that girls with autism were more likely to be shunned by others during adolescence due to

this being a time when individuals are expected to fit in with the group, and participants reported or

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recollected feelings of isolation, loneliness, being a ‘social misfit’ and bullying. (Cook, Ogden and

Winstone 2018; Cridland et al. 2014; Honeybourne 2015; Moyse and Porter 2015).

Well-being

There was a recognition that the often-negative experiences of autistic girls and young women

within the education system had a detrimental impact on their well-being including high levels of

stress and anxiety (Cook, Ogden and Winstone 2018) and feelings of depression (Honeybourne

2015), often a consequence of the tendency for autistic girls to internalise their difficulties (Jarman

and Rayner, 2015; Moyse and Porter 2015).

Discussion

Summary of findings

This investigative review aimed to summarise the literature relating to school experiences of autistic

girls. To date research in this area remains limited and only eight studies were identified which met

inclusion criteria, meaning only tentative conclusions can be drawn from such a small sample. Data

were analysed using the conceptual framework as a tool to add rigour to the analysis by ensuring

that key themes in the broader literature were considered in relation to girls whilst also allowing for

inductive themes to emerge. The review highlights the importance of contextualising the school

experiences of autistic females within the broader literature on autism and education, and reported

experiences largely fit with those of autistic children and young people in general. Examples

included difficulties managing noisy school environments (Honeybourne 2015; Moyse & Porter,

2015), challenges accessing the curriculum (Jarman & Rayner 2015), difficulties with transitions

(Moyse and Porter 2015) and challenges managing social relationships (Cridland et al. 2014; Dean,

Kasari and Chamberlain 2017; Honeybourne 2015). However, there were areas where experiences

were more specific to females; for example, the extent to which autistic girls mask or camouflage

their symptoms which can lead to the minimising of social challenges experienced by autistic

females in comparison to their male peers. Such coping skills, defined as ‘masquerading’ or

‘camouflaging’ have been documented in literature pertaining to the male experience (e.g.

Humphrey and Lewis 2008; Lai et al. 2015); however, the suggestion is that females on the autism

spectrum are more skilful at this than their male peers (Attwood 2007). A further key difference

linked to this was reported variation in the perceptions of staff and parents in relation to the level of

difficulty experienced by autistic girls. Notably, parents were more likely to consider their daughter

as experiencing significant difficulties managing the school environment, whereas staff perspectives

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often highlighted how well the girls appeared to be coping. These differences in staff and parent

perception may reflect girls’ increased tendency to internalise their difficulties (Mandy et al. 2012).

The studies illustrate autistic girls and young women, like autistic boys and young men do not

present as a homogenous group. Significantly, that their school experiences are varied and broad,

underpinned by a range of individual factors.

A limitation of the research is that none of the included studies were categorised as high quality,

which perhaps reflects the emerging nature of the field in drawing upon small self-selecting or

community samples which may result in a lower overall quality of the evidence base (Bond et al.,

2013). Although it is possible to draw some limited conclusions from a small number of studies,

more work is clearly needed to use these exploratory studies as the foundation for development of a

broader and more robust evidence base relating to autistic girls’ school experiences.

Implications for professional practice

The review highlights the importance of masking in relation to autistic girls and the necessity to look

beyond external presentation. Tensions between parents and teachers were evident, especially in

terms of the prevailing sentiment that autism is a male condition. Thus, there is considerable scope

for specialised training of educational staff to enhance their understanding of autism in females,

facilitating more effective levels of support and dispelling the stereotype that ‘females cannot have

ASD’ (Jarman and Rayner 2015, p138; Morewood, Tomlinson and Bond in press 2019).

Training needs to focus on aspects of girls’ experiences raised in this review and in the broader

literature including mental health difficulties (Eaton, in press 2019) and the specific communication

challenges faced by autistic girls (Bauminger et al. 2008), incorporating a focus on personal

experiences to increase empathy in staff (Barrett 2006).

This review highlights marked differences in the social challenges faced by autistic girls (Dean et al.

2014). Autistic girls were ‘easily overlooked’ and their social behaviour from a distance resembled

that of TD girls, whereas the social challenges for autistic boys were more obvious (Dean, Harwood

and Kasari 2017). Thus, teachers need to look out for more subtle social difficulties in girls which at

first glance may not seem apparent. Furthermore, the increased likelihood of ‘relational aggression’

calls for more specialised social skills interventions which focus on improving the quality of

interactions with peers and supporting the interpretation of subtle social cues. The ‘Girls’ Night Out’

(GNO) model (Jamison and Schuttler 2017) is an example of a social skill and self-care programme

designed to address the unique needs of autistic adolescent females targeting social behaviours

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(e.g., reciprocal conversation, shared interests, independence) related to the social norms of

adolescent females.

Limitations of the current review

Although the use of a framework approach was a helpful scaffold which strengthened the analysis,

this methodology is still in its infancy and thus there will be variations in the subjective

interpretation of study findings potentially impacting reliability and validity. Furthermore, where

minimal or no mention was made in relation to an aspect of the framework within the studies (e.g.

school ethos/policy) this is likely to reflect the specific review research question and/or foci across a

small number of studies rather than being indicative that these themes are not important in relation

to girls.

Implications for research

The current review highlights the need for robust, high quality research in this area. There were gaps

for autistic girls in areas of the conceptual map and findings from single studies which warrant

further research e.g. girls developing their own coping strategies (Moyes and Porter, 2015). The

included studies were also cross-sectional, indicating a need for longitudinal research to better

understanding of the educational experiences of autistic females over time. Furthermore, few of the

included studies sought to understand current experiences of school from the perspective of the

girls themselves. Although empirical research in this area is limited, other aspects of education for

girls which have been discussed in the literature, such as meeting mental health needs in school

(Eaton, 2017), school refusal (O’Hagan and Bond, in press 2019), puberty and sex and relationships

education (Cridland et al, 2014) would also benefit from further exploration.

Conclusion

Despite the limitations discussed, the current review is the first systematic analysis of the school

experiences of autistic girls and adolescents, and as such offers a summary of the current state of

knowledge in this area, highlighting potential areas for future research. The main findings were that

although their experiences were similar to their autistic male peers in some respects, there exist key

differences which need to be considered, most notably the recognition that autistic girls are more

likely to mask their difficulties. It is hoped that these findings will assist educators in furthering their

understanding of the experiences of autistic girls.

Declaration of interest statement

No potential conflict of interest was reported by the authors.

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